The good news is that until April 6, 2009, there’s a terrific deal on sublingual (under the tongue) vitamin B12 via the Life Extension Overstock Sale for just $6.40 for a bottle of 60 tablets of 5000mcg (5mg) each. These are the more expensive and readily metabolized methylcobalamin form, so folks whose livers cannot convert the common cheap cyanocobalamin form of B12 can still benefit. Even in a healthy normal person, the liver converts just 1% of cyanocobalamin into the biologically active methylcobalamin form.

Click here to be taken to the product page for Life Extension’s 5000mcg (5mg) methylcobalamin lozenges.

Diseases Related to Vitamin B12 Deficiency

Vitamin B12 deficiency is often involved in causing or worsening high homocysteine levels (an indicator of vascular and heart disease and stroke risk), anemia, nervous system and brain problems such as multiple sclerosis and Alzheimer’s, and sleep disorders. Such people may also be experiencing folate (folic acid) deficiencies, too.

B12 is also involved in the production of neurotransmitters including serotonin, dopamine, and norepinephrine. As you may know, there is a whole class of anti-depressant drugs called SSRIs (Selective Serotonin Reuptake Inhibitors) designed to boost serotonin in the brain to alleviate depression. Some of these depressed people might be helped simply from more vitamin B12 in their diets. Other people who suffer from unusual fatigue and poor memory, also sometimes related to B12 deficiencies, could also be helped by more B12.

Drugs, Aging, and Diets Increase Risk of B12 Deficiency

Supplementing with B12 is important for people using antacids and/or acid reflux drugs such as Prilosec (omeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Nexium (esomeprazole), Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), Axid (nizatidine), and similar medicines. These medicines lower stomach acid and pepsin levels, which makes it harder for the digestive system to unbind the B12 in the food from proteins and thus inhibits B12 absorption. Older people often lack adequate stomach acid to fully digest their food, and are more likely to have B12 deficiency, too.

Diabetics are also at elevated risk of B12 deficiency. The common diabetes drug Metformin (glucophage) reduces blood serum B12 and folate levels and can lead to high homocysteine levels and accompanying heart disease. Taking B12 and folate (folic acid) supplements can prevent this.

Since B12 is mostly present in animal products, vitamin B12 deficiency is a widespread problem for vegetarians unless they take dietary supplements to correct the lack of B12 in their diets. Vegetarians who eat dairy products and eggs are less likely to have B12 deficiency, but are still at high risk as even one egg contains only 10% of the US RDA for vitamin B12.

Note that like many trace nutrients, B12 is measured in micrograms, also written as μg or mcg. Many other nutrients, for instance vitamin C, are commonly measured in milligrams which is usually abbreviated as “mg”. 1000 micrograms equals 1 milligram.

Getting Enough B12 Likely Depends Upon Supplements

Even if you eat enough of the right foods to get the US RDA for most adults for vitamin B12 of 2.4 mcg, you are at risk for B12 deficiency. Studies suggest that 39% or more of the population suffers from B12 deficiency, with rates upwards of 92% of vegans suffering from it. There are calls to raise the RDA of B12 to 6 mcg per day, but even that appears to be insufficient for many people, especially those with B12-related health problems and the elderly.

Injection B12 used to be a common way to treat B12 deficiencies as oral absorption of B12 is not as high as injections can achieve. However, high daily doses of oral B12 have been found to be similarly effective and are more comfortable (unless you like needles!) and less expensive. Oral methylcobalamin is particularly effective. Oral daily supplementation at 2000mcg per day also appears to lead to higher blood serum B12 levels over time than 1000mcg monthly injection B12 does.

High doses of 2000mcg (2mg) per day appear to cure most symptoms of B12 deficiency, but 3000mcg (3mg) is often used for sleep disorders and people with neural degenerative diseases like Alzheimer’s are recommended to take even 4000mcg per day plus SAMe (S-adenosylmethionine) supplements.

There is little risk of overdosing on oral B12 supplements. The risk is viewed as so low that it was decided not to issue an upper limit on consumption. That said, it isn’t a great idea to pop B12 tablets into your mouth like a handful of M&Ms. Even though it’s not likely you’d suffer any health problems, it would be an expensive habit. You’d be better off saving your money to spend on other dietary supplements. The 5000mcg in the previously mentioned Life Extension methylcobalamin tablets is likely more than enough for virtually any common dietary need, and at US$6.40 for 60 of them it works out to about 11 cents per day or $39 per year if you took them every day.

Health and Cost Advantages of B12 Supplements

It’s interesting to note that methylcobalamin B12 supplements may help balance the body’s store of other essential nutrients. For instance, SAMe (S-adenosylmethionine) is used to convert cyanocobalamin to methylcobalamin in the liver. B12 and folate are also necessary for the synthesis of SAMe in the body. SAMe is further related to production of neurotransmitters and maintenance of homocysteine levels by helping to convert toxic homocysteine to safer methionine. SAMe doesn’t work properly unless you have enough B12, B6, and folate in your body. Consuming methylcobalamin may help save SAMe for other purposes in the body and boost its levels and effectiveness, thus solving other deficiencies.

Furthermore, SAMe is generally a much more expensive nutritional supplement than methylcobalamin. For instance, Costco’s current price on 90 tablets of NatureMade 200mg SAMe is $39.89. They recommend taking two tablets per day for 400mg, meaning it’s about $40 for just 45 days supply or $324 for a year.

We’re thinking that it might be more cost effective and health beneficial for most people to use lower dosages of SAMe supplements (perhaps 200mg per day?) and spend the savings on good quality multivitamins, B-complex vitamins including B6, B12, and folate, vitamin D3 (preferably 1000 IU or more per day), and omega-3 supplements such as fish oil and flax seed. You can get all of those and more for the $162 you’d save by halving the dose of that SAMe product.

If you’re set on getting your B12 via natural diet alone, consider adding mussels, clams, and crab to your daily cuisine. They all contain high levels of B12. But even if you eat a can of clams per day, your B12 intake will still not be as high as that you can get with inexpensive 1000mcg or higher B12 tablets. Based upon the wide-ranging health problems caused or aggravated by B12 deficiency and the large portion of the population with low B12 levels, we strongly believe that virtually everybody except those with a strong reason not to do so (such as an extremely rare allergy to cobalt, an element in B12) should be taking B12 supplements.

Methylcobalamin, 5 mg 60 lozenges
(to be dissolved in the mouth)

Life Extension Item Catalog Number: 00537
Methylcobalamin is the form of vitamin B12 active in the central nervous system. It is an active coenzyme of the vitamin B12 analogs, that are essential for cell growth and replication. The liver may not convert cyanocobalamin, the common supplemental form of vitamin B12, into adequate amounts of methyl-cobalamin the body may need for proper neuronal functioning.